Healthy Families Health Plans

Health Plans

This chart lists the health plans in your county. The chart answers common questions about the plans. Information about each plan was provided by the plan. Click on each plan name for a description of the plan.

San Diego County
.	Community Health Group (San Diego)	Blue Cross HMO	Blue Shield EPO	Health Net HMO	Kaiser Permanente	Molina Healthcare
Are all members required to have a primary care physician (PCP)?	Yes	Yes	No	Yes	Encouraged	Yes
Should a member get a referral from a PCP before going to a specialist?	Yes	Yes	No	Yes	Yes	Yes
How many times can members change their PCP in one benefit year?	12	Unlimited	N/A	12	Unlimited	12
Does the plan offer a prescription drug mail-in program?	Yes	Yes	Yes	Yes	Yes	No
Does the plan ask me to substitute generic for brand name drugs, except when medically necessary?	Yes	Yes	Yes	Yes	Yes	Yes
Does the plan provide the following optional benefits:
Biofeedback	No	No	No	No	No	No
Acupuncture	Yes	No	No	No	No	Yes
Chiropractic	Yes	No	No	Yes	Yes	Yes
More than 20 outpatient alcohol and drug visits per benefit year	No	No	No	No	Yes	No
Elective abortions	Yes	Yes	Yes	Yes	Yes	Yes
Health Plan Statistics:
Total number of CA members**	99,645	2,382,242	6,879	2,251,969	6,230,600	333,000
What types of specialists are offered as PCPs in this plan?
General Practice	Yes	Yes	N/A	Yes	Yes	Yes
Family Practice	Yes	Yes	N/A	Yes	Yes	Yes
Pediatrician	Yes	Yes	N/A	Yes	Yes	Yes
OB/GYN	Yes	Yes	N/A	Yes	Yes	Yes
Internal Medicine	Yes	Yes	N/A	Yes	Yes	Yes
Other:
Quality Accreditations (NCQA/JCAHO)?	NCQA	NCQA	N/A	NCQA	NCQA/JCAHO	NCQA
Type of Accreditation	Commendable	Excellent (Medicaid)	N/A	Excellent (Commercial Product)	Excellent (Commercial Product)	Commendable (Medicaid HMO)
Does the plan require its members to use Binding Arbitration to resolve disputes?**	Yes (excludes medical malpractice)	Yes (includes medical malpractice)	No	Yes (includes medical malpractice)	Yes (includes medical malpractice)	No

* This number represents the insurance plan's membership as of January 1, 2007.

** To get additional information about each insurance plan's dispute resolution provisions, call the plan or refer to the plan's Disclosure Form and Evidence of Coverage booklet, which is available upon request from each health plan.

NOTE: These summaries are for information only. This is not a contract. For a detailed and precise statement of benefits and exclusions, please refer to you Evidence of Coverage/Certificate of Insurance.